High Deductible Health Plan: Overview

  In-Network Out-of-Network

CALENDAR YEAR DEDUCTIBLE1 (CYD)
Unless otherwise indicated, all benefits are subject to CYD. Family deductible can be satisfied by one or more covered members during a calendar year. In-Network and Out-of-Network deductibles are met separately.

$2,250 for individual

$3,750 for individual

$4,500 for family

$7,500 for 2-person/3-person/family

OUT-OF-POCKET MAXIMUM2 (OOP)
Once the OOP maximum is met, benefits are provided at 100% for a member for the remainder of the calendar year. Family Out of Pocket Maximum can be satisfied by one or more covered members during a calendar year. This applies to in-network provider services only. 

$4,500 for $2,250 deductible

$5,625 for $3,750 deductible

$9,000 for $4,500 deductible

$11,250 for $7,500 deductible

 

 Unlimited

LIFETIME BENEFIT MAXIMUM

 Unlimited

FOOTNOTES

1 Deductible – the dollar amount of covered services that must be incurred and paid first by a member each calendar year before plan benefits begin.

2 Once the OOP maximum is met, benefits are provided at 100% for a member(s) for the remainder of the calendar year. This applies to in-network provider services only. There is no Out of Pocket Maximum when out of network providers are used.